Characteristics and recognition of early infections in patients treated with commercial anti-CD19 CAR-T cells.
Adult
Aged
Aged, 80 and over
Antigens, CD19
/ immunology
Bacterial Infections
/ diagnosis
Comorbidity
Disease Management
Disease Susceptibility
Female
Humans
Immunotherapy, Adoptive
/ adverse effects
Incidence
Infections
/ diagnosis
Lymphoma, Large B-Cell, Diffuse
/ complications
Male
Middle Aged
Odds Ratio
Receptors, Chimeric Antigen
/ immunology
Risk Factors
Treatment Outcome
Young Adult
CAR-T cells
infection
lymphoma
Journal
European journal of haematology
ISSN: 1600-0609
Titre abrégé: Eur J Haematol
Pays: England
ID NLM: 8703985
Informations de publication
Date de publication:
Jan 2022
Jan 2022
Historique:
revised:
22
09
2021
received:
23
07
2021
accepted:
24
09
2021
pubmed:
27
9
2021
medline:
15
3
2022
entrez:
26
9
2021
Statut:
ppublish
Résumé
The characteristics of infections following chimeric antigen receptor T (CAR-T) cells targeting CD19 in real-word population are obscure. We analyzed infections' characteristics in the first month among consecutive patients with diffuse large B-cell lymphoma (DLBCL) (n = 60, median age, 69.3 years), treated with commercial CAR-T cells. ECOG performance status (PS) was 2-3 in most patients (58%). Infections were observed in 45% of patients (16, 27%, bacterial infections, and 14, 23%, viral infections). Bacterial infection included clinically documented infection in 7 (Pneumonia, n = 5; periodontal infection, n = 1; and cellulitis, n = 1) and microbiology documented infection (MDI) in 9 patients (Gram-negative rod, n = 5; Gram-positive cocci, n = 3, bacteremia; polymicrobial, n = 1). The most common viral infection was cytomegalovirus (CMV) reactivation (n = 10, 17%) leading to initiation of anti-CMV treatment in 6 (60%) among these patients. None had CMV disease. In univariate analysis, immune effector cell-associated neurotoxicity syndrome (ICANS) was associated with higher incidence of bacterial infection (OR=4.5, P = .018), while there was a trend for lower incidence of bacterial infections in patients with chemosensitive disease to bridging therapy (OR=0.375, P = .074). Age or PS was not associated with increased risk of bacterial infection. Increase in C-reactive protein (CRP) prior to fever onset was associated with microbiologically documented infections. We conclude that infections are common in the first month following CAR-T-cell administration, however, were not increased in elderly patients or those presenting with poorer PS. Increase in CRP prior to fever onset could support infection over cytokine release syndrome.
Substances chimiques
Antigens, CD19
0
Receptors, Chimeric Antigen
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
52-60Informations de copyright
© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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